Provider Demographics
NPI:1114399094
Name:GUILLORY, RAYMOND CHRISTOPHER (SUDCC III)
Entity type:Individual
Prefix:
First Name:RAYMOND
Middle Name:CHRISTOPHER
Last Name:GUILLORY
Suffix:
Gender:M
Credentials:SUDCC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11902 ROSECRANS AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4197
Mailing Address - Country:US
Mailing Address - Phone:562-929-7188
Mailing Address - Fax:
Practice Address - Street 1:11902 ROSECRANS AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4197
Practice Address - Country:US
Practice Address - Phone:562-929-7188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)